The amount of people not able to work because of sickness has risen sharply in recent years and is now at the highest level since records began.[1] A new health revolution may be needed to solve the crisis.
For ITV's Tonight programme, 'Britain On The Sick' (ITV1 Thursday November 16th 8:30pm) I've been looking at one of the biggest issues affecting the well being of the nation - the rise of long-term sickness,.
Lord Bethell, a minister for Health during the Covid crisis, told me we are a ‘sick nation… I really don't think the country has a bigger problem right now.”
He has called on the government to create a Director of National Health with responsibility to improve the productivity of the country and to intervene in matters that hit the nation's health
The Office For Budget Responsibility says the rise in long-term sickness is costing us around £30 billion
It's not just affecting businesses and the NHS, Prison officer Mark Fairhurst is Chair of the Prison Officers union. He told Tonight that: “I was in Wandsworth a couple of weeks ago after the escape to see how everyone was, and they should have had 130 prison officers on duty to look after 1600 prisoners. They only had 94.”
The Resolution Foundation’s analysis of the rise in long-term sickness highlights a particular problem amongst younger age groups. Resolution Foundation Economist, Louise Murphy told Tonight that “The rise in the number of younger people who are out of work because of ill health is particularly concerning – with a significant rise in mental health issues, which could affect their long-term participation in the work force.”
Data from the latest Labour Force Survey show a staggering rise in the number of days lost due to sickness, due no doubt to a large extent by the Covid pandemic. However, the problems have been longer lasting than the pandemic and suggests other forces are having a big effect.
Source: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2022
There has also been a huge rise in the number of people not being at work because of reporting 5 or more health issues
Reasons People Report Sick
The biggest reason report sick from work is depression, bad nerves and anxiety
Stress, burnout and mental health problems are plaguing the workforce, while at the same time, the government wants to reduce the number of people out of work to boost the economy.[2]
Who Decides Who is Unwell Enough Not to Work?
Concerns have been growing about who can issue sicknotes and how easy it is to get them. Although most people know you can get a note from your GP, you can also get them from a nurse, occupational therapist, pharmacist or a physiotherapist.
But that’s not all, if their employer agrees, the employee can use a similar document called an Allied Health Professional (AHP) Health and Work Report instead. Someone working in any of the following occupations can provide this, including:
Art Therapist
Chiropodist
Dietitian
Music therapist[3]
Sickness absence levels had been following a downward trend since 2002, but following the pandemic, the number of people not working due to long term sickness rose by four hundred thousand, and now stands at two and a half million. [4]
A minister for Health during the Covid crisis, Lord Bethell told ITV's Tonight programme that we are still a ‘sick nation… I really don't think the country has a bigger problem right now.” He blames the government, lobby groups and how we don’t take the issue seriously. He told Tonight that “I'm fed up with people's scapegoating the NHS. Doctors and nurses are overstretched because we've got too much illness in this country. I would like to see a government that stood up to the political challenges and vested interests.”
He has called on the government to create a Director of National Health with responsibility to improve the productivity of the country and to intervene in matters that hit the nation's health. The Victorians, he says, did an enormous amount to promote public health but now it's been massively departmentalised, to the detriment to both the health and the wealth of the nation. To fix the problem, he is calling on the government to make our health a central part of housing, education and food policy.
'Sick Note Britain' certainly presents a huge challenge for the country. It means that the quality of people’s lives are worsening as they live with increasing health challenges that the NHS and local council grants, find increasingly difficult to support.
In economic terms, it means our welfare bill is up. It means that employers can't find the workforce they need. It means that the cost to the NHS are higher than they should be and the amount paid in income tax is lower than it should be.
The 31 Billion Pound Cost of Ill Health
In its latest report, the Office for Budget Responsibility claims that “A sustained rise in health-related inactivity poses a significant risk to fiscal sustainability.” They claim that the increase in working-age inactivity due to long-term sickness since the pandemic, alongside rising ill-health among those in work) has already added £6.8 billion to the annual welfare bill, cost £8.9 billion in foregone tax receipts, and therefore added £15.7 billion (0.6 per cent of GDP) to annual borrowing.[5]
Bethell claims that this “is a phenomenal amount of money that we simply can't afford as a country.” But this is not an issue he thinks can be fixed with just funnelling more money to the NHS. He believes that the fault for sick note Britain lies in our failure to take personal responsibility for how we behave.
He says “I think we've got the wrong idea of what the NHS can do in this country. The great thing about the NHS is the social contract around being free at the point of delivery open to everyone who needs it. But that is a very one-way sounding contract. It sounds like the, the NHS is responsible for the individual's health, and that was true a long time ago when frankly, what hospitals did was to help you if you had an accident or a, or a chronic disease. But now most of the diseases we have are much more about our lifestyles than they are about contagion or, or, or accidents. We need to rewrite that thinking actually the people who need to be involved in our health include our employers, include the vested interest that the industries that are, are polluting, uh, Don Nation's health, our housing, the, the, the fresh air, it's mouldy homes, dirty air, internet, filth, uh, and junk food that are the main drivers of ill health. And we need to turn our attention to those.”
He also told ITV’s Tonight programme that government has been too short-term in its approach: “There is a Treasury problem that they don't believe many of the spend now to save later type schemes. Their scepticism is understandable, but frankly has proved to be a mistake.”
And he believes the government is behind public opinion: “I do think that the people are ahead of the politicians on this. I I recognize that there are vested interests at play in there. You know, we have, uh, the beer and public industry. We have the food industry, we have big tech, we have, uh, the car industry all going to Downing Street and the Treasury endlessly ringing their hands, worrying that any form of change will cost Jo jobs in the short term. But I, I deeply question all of that. We saw in sidle these sugary drinks industry levy, uh, a the use of the fiscal system that has dramatically reduced the amount of sugar in fizzy drinks. The result of that has been money that's gone into school playing fields that was ated. Uh, and we've also seen an increase in the sale of fizzy drinks. So that is an example of the kind of win-win that you can get if you are thoughtful about the policies in this area.”
Our sick note culture can also be a problem. If you want to take time off work, you need to present what is generally called a sick note, although they are properly known as a Fit Note. The average appointment with a GP lasts less than 10 minutes[6]. It’s not clear how doctors can properly assess whether someone is fit to work because of stress or ill health in that time.
Dr. Adrian Massey who contributed to the DWP’s Fit Note Review says “Workers may decide to call in sick in the mistaken benefit that work is likely to be harmful, if they are experiencing any level of symptoms, when generally the precise opposite is true: work – with the routine, structure, security and social interaction it offers – is likely to be helpful.[7]
Dr Amir Khan told Tonight “I think GP’s and primary care staff are under a lot of pressure. And sometimes the pressure is such that you might find the easiest thing is to give a sick note. But that's the exception, not the rule. You know, we will, always do our best to do what's best for the patient.” And although there are faults in the system, most people, he believes are honest “There's no doubt that there are patients, who come in wanting a sick note that don't need it. There's, there's absolutely no doubt in my mind, and I try my best to identify them. But it's unfair because most of the people I see are genuine, uh, and need time off work.”
And it’s not just the NHS that suffers from the rise in long-term illness. Businesses are often struggling to get staff and sometimes that becomes more than just a business issue. The Prison Service has also been hit with high level since 2019[8]
At Wandsworth prison in London staff absence may have contributed to the recent escape of suspected terrorist Daniel Khalife. Luckily for the public, Khalife was caught four days later. But on the day that he escaped 80 prison officers failed to turn up for duty, some may not have been due to illness… but that’s 40 percent of the staff that were supposed to be working.[9]
And this wasn’t a one off. In a 2021 inspection at the prison, 30 percent of staff were either off sick or didn’t turn up for work[10].
Mark Fairhurst is a serving prison officer in Liverpool and also the Chair of the Prison Officers union. He told me that: “I was in Wandsworth a couple of weeks ago after the escape to see how everyone was, and they should have had 130 prison officers on duty to look after 1600 prisoners. They only had 94.”
At its last inspection Wandsworth received the lowest possible rating. But the government has rejected the idea that staff shortages resulted in the escape.[11]
Mark told me that this “Is the biggest crisis I've ever known in the last 30 years.
So for example, the last weekend at Liverpool Prison, we only had 31 prison officers to look after over 800 inmates. We should have had at least 70 prison officers on duty of
a weekend. We had 40 on the sick.”
Long term illness isn’t the only problem affecting our workforce. Employee sick days are the highest they’ve been for a decade. And in the public sector the figure is nearly twice as high - with people taking off an average of ten and a half days a year.[12]
The private sector hasn’t been immune to increased sick days however, with employees taking off an average of nearly six each year.[13]
The Resolution Foundation’s analysis of the rise in long-term sickness highlights a particular problem amongst younger age groups. The Resolution Foundation’s analysis of the rise in long-term sickness highlights a particular problem amongst younger age groups. Resolution Foundation Economist, Louise Murphy told Tonight “The sharp increase in the number of younger people who are out of work because of ill health - with mental health issues largely driving this trend - is particularlyconcerning as it can have a long-term scarring effect on their future employment and career prospects.”
If this is a long-term trend – it has serious implications on the nature of ther workforce and how we should approach long-term sickness. A new health revolution may be needed if we are to combat this new challenge.
This article is completely separate and independent from the programme which is broadcast on 16.11.23 on ITV1 at 8:30pm
Britain On The Sick - With Adam Shaw
ITV Tonight
Produced & Directed by Daniel Harrison
Sources: [1] 1 ONS: ‘The number of people out of the labour market because of long-term sickness has been rising in recent years’ [2] https://www.gov.uk/government/news/government-announces-new-welfare-reforms-to-help-thousands-into-work [3] https://www.gov.uk/taking-sick-leave [4] 4 ONS stats on post covid levels ‘The number of people economically inactive because of long-term sickness has risen to over 2.5 million people, an increase of over 400,000 since the start of the coronavirus (COVID-19)” / ONS stats since records began. Spreadsheet states “ The sickness absence rate rose to 2.6% in 2022; this is the highest sickness absence rate since 2004” [5] https://obr.uk/frs/fiscal-risks-and-sustainability-july-2023/#chapter-2 [6] https://www.independent.co.uk/news/health/gp-appointments-ten-minutes-phase-out-2030-royal-college-nhs-a8922106.html [7] Sick Note Britain pg 18 [8] 23 Gov Prison Stats “HMPPS staff sickness accounted for an average of 13.8 working days per person lost for the 12 months to the end of December 2022. This is 3.5 [9] 25 Damian Hinds Statement on Parliament Website (14 Sept 23) “On 6 September 2023, 1,594 prisoners were held at HMP Wandsworth. 125 Band 3 Prison Officers at the prison attended their shift on that day. This equates to 61 per cent of [10] 26 Report on an unannounced inspection of HMP Wandsworth by HM Chief Inspector of Prisons “Staffing shortfalls were preventing the prison from running a decent and predictable [11] 27 Damian Hinds Statement on Parliament Website (14 Sept 23) “An initial investigation into Daniel Khalife’s escape did not find the staffing level to be a contributing factor.” [12] https://www.cipd.org/uk/knowledge/reports/health-well-being-work/ [13] https://www.cipd.org/uk/knowledge/reports/health-well-being-work/